All *ANTIEMETICS*

Akynzeo CAPSULE 300-0.5 MG Oral
Akynzeo CAPSULE 300-0.5 MG Oral

Netupitant-Palonosetron

Tier: 3
PA Type: No Prior Authorization
ST: Y
Akynzeo CAPSULE 300-0.5 MG Oral
Akynzeo CAPSULE 300-0.5 MG Oral

Netupitant-Palonosetron

Tier: 3
PA Type: No Prior Authorization
ST: Y
Akynzeo Solution 235-0.25 MG/20ML Intravenous
Akynzeo Solution 235-0.25 MG/20ML Intravenous

Fosnetupitant-Palonosetron

Tier: 4
PA Type: No Prior Authorization
ST: N
Akynzeo Solution Reconstituted 235-0.25 MG Intravenous
Akynzeo Solution Reconstituted 235-0.25 MG Intravenous

Fosnetupitant-Palonosetron

Tier: 4
PA Type: No Prior Authorization
ST: N
Aloxi Solution 0.25 MG/5ML Intravenous
Aloxi Solution 0.25 MG/5ML Intravenous

Palonosetron HCl

Tier: 4
PA Type: No Prior Authorization
ST: N
Aloxi Solution 0.25 MG/5ML Intravenous
Aloxi Solution 0.25 MG/5ML Intravenous

Palonosetron HCl

Tier: 4
PA Type: No Prior Authorization
ST: N
Anzemet Tablet 100 MG Oral
Anzemet Tablet 100 MG Oral

Dolasetron Mesylate

Tier: 3
PA Type: No Prior Authorization
ST: N
Anzemet Tablet 50 MG Oral
Anzemet Tablet 50 MG Oral

Dolasetron Mesylate

Tier: 3
PA Type: No Prior Authorization
ST: N
Aprepitant 80 & 125 MG Oral
Aprepitant 80 & 125 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y
Aprepitant Capsule 125 MG Oral
Aprepitant Capsule 125 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y
Aprepitant Capsule 125 MG Oral
Aprepitant Capsule 125 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y
Aprepitant Capsule 125 MG Oral
Aprepitant Capsule 125 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y